I am aware that I haven’t posted many updates to Low Vision News recently. This has been due to a combination of laziness and being too busy to write new posts!

I am continuing to review for the Faculty of 1000 low vision section and encourage people interested in low vision research to look at this site. It serves a similar purpose to my site: it gives a precis of current low vision research and reviews published papers. It also has the advantage of being contributed to by others, so the opinions you are getting are not just mine!

I will continue to add to this site when I feel inspired to (after courses, conferences and so on) but the reviewing function will now be performed on Faculty of 1000.

Faculty of 1000 (f1000) is a “post-publication peer review” site where researchers and clinicians are invited to comment on papers which they have recently read. The ophthalmology section of f1000 has just launched and I am pleased to report that Low Vision is a recognised subsection of the website. It can be accessed at:

The evaluations published so far are quite complimentary. I imagine that people are more likely to comment on papers which they like (or which they very much dislike!). This site should become a useful resource for identifying new research papers in low vision and for seeing some expert commentary on these publications.

I am very pleased that Faculty of 1000 recognised Low Vision as an area which warrants a separate section of their website, and look forward to reading some interesting reviews of new low vision papers.

[Disclaimer: I am a member of Faculty of 1000 for the low vision section; I do not receive any payment for this]

The most interesting thing for me was that there are lots of Randomised Controlled Trials (RCTs) in progress in low vision research. Well designed RCTs are a powerful tool to investigate the effect of an intervention (such as a training programme) and are essential for us to really understand the benefits of different types of low vision rehabilitation. They are also increasingly necessary for us to continue receiving funding for low vision services (whether that funding is from the state or from an insurer).

Research highlights for me included Else Havik’s work on navigation of shared spaces (streets with no kerbs, signs or road markings, where drivers are encouraged to drive considerately); Kez Latham’s work on likelihood of success with low vision aids (if your near vision is poorer then N22 with a +2.50DS spectacle add and your contrast sensitivity is worse then 1.05 log units you’re unlikely to read newsprint with a magnifier); and Carlos Aguilar’s work on gaze-contingent magnification in macular disease.

I didn’t like everything about the meeting: as is often the case, there were many clashes on the programme and sometimes I had to choose to miss something which looked interesting. I didn’t like the keynote speaker being interrupted as the junior government minister attending the opening ceremony wanted to leave (and we had to stand as a sign of respect, although the speaker was far more deserving of that respect); and the weather was far too hot for me! Having said that, I’m looking forward to the 11th International meeting: Vision 2014, Melbourne.

I decided to take a month away from writing this blog, so here (belatedly) is the first post of 2011. In it I will preview the conferences which we can look forward to this year.

Of course, the biggest low vision conference of them all is the three-yearly International Conference on Low Vision, which is organised by the International Society of Low Vision Rehabilitation and Research. This will take place in just over two weeks in Kuala Lumpur, Malaysia. I have seen a preview of the programme and there is plenty to look forward to: a full preview (and review) will be on this site in due course.

My boss (and former PhD supervisor) Gary Rubin will be giving the “excellence in research” address at this year’s Envision meeting in St Louis, Missouri, USA this September. I am not sure whether I will be going to Envision this year: it depends on many factors (funding, time off from work, etc.) but regular readers will know I have always enjoyed this conference.

I will definitely be going to the European Academy of Optometry and Optics annual meeting in Prague this May though. This is a relatively new meeting which I have not been to previously. I will be presenting some of our research on the Kindle, iPad and other electronic books for people with visual impairment which I have written about here before. I am not sure how much low vision will be at this meeting but will report back.

There will also be some low vision presentations at the European Conference on Eye Movements, in Marseille this August. The South of France in summer appeals to me and I hope to be presenting some work on fixation stability at this meeting.

Other big meetings with low vision content include ARVO (the Association for Research in Vision and Ophthalmology) this May and the American Academy of Optometry meeting in Boston in October. After KL I may stick to European meetings this year: I am sure my carbon footprint is large enough already, and I could do with some time doing research rather than just talking about it at conferences!

I recently read this excellent paper by Graeme Douglas and colleagues in Birmingham. They interviewed more than 1,000 people who are registered as sight impaired or severely sight impaired in the UK. The study is well designed and very carefully controlled, and produced several very interesting findings.

First, 11% of people who are registered as sight impaired don’t know what eye disease causes their visual loss, even when prompted with a list of likely diagnoses. Don’t forget these are people who have been registered as sight impaired (in the UK, this means they must have been examined by an ophthalmologist, signed a registration certificate, and agreed for their details to go to their local authority. This figure rises to 13% of those of working age.

Second, and reassuringly, 71% of the sample use a low vision aid. 23% have previously used low vision aids, and only 7% have never tried low vision aids. Given that many people may not benefit from magnifiers (those with no light perception; those with very restricted visual fields but good visual acuity), it seems that the British system for low vision aid provision is working relatively well (at least for those who have been in contact with a hospital). I am delighted that there is not a category for “have seen low vision aids but can not afford them” as would happen if we didn’t have a National Health Service. A strength of this study is that the telephone interview technique means people are more likely to be honest about low vision aid use: if a clinician audits device use participants are likely to claim they use a low vision aid to please the person who dispensed it to them.

Of course this study doesn’t address the thousands of people who have visual impairment but who have not been seen in a medical setting. This should be a future area of research in this area. I would also be fascinated to know whether the one-in-ten people who can’t name their eye disease are happily ignorant (“don’t tell me doc, it doesn’t matter to me”) or whether they would rather be able to know more about their condition.

This is one of the best, and most important, papers in British low vision research I have read for some time.

As regular readers will know, I have reviewed several electronic readers on this blog to determine whether they are useful for people with low vision (see my reviews of the Kindle 2; Sony Reader; and iPad). Amazon have recently released a new version of the Kindle (Kindle3) and I have bought one for myself (all the other reviews I have done have been on borrowed devices).

A noticable feature about the new Kindle is how small and light it is. Before my Kindle arrived I saw an older man in the waiting area outside our low vision clinic reading one with a Keeler segment (a small high powered spectacle lens, which requires text to be held a couple of inches from the face). He remarked how easy it was to hold the Kindle at 5cm for a prolonged period of time, unlike a heavier book or larger newspaper.

Amazon claim that the screen has higher contrast as well. I was sceptical about this claim but measured the Michelson contrast (in a normal office environment) to be 73% (compared to 60% for the earlier Kindle). Whilst still nowhere near as high as the 99% which the iPad can achieve, this is still an improvement on the previous version. Perhaps more significantly the text can be enlarged further as well: to 5M (5 times the size of newsprint; equivalent to 1.3logMAR or N40). It also incorporates text-to-speech. In my limited experience with the device most new books do not have text-to-speech enabled (a decision which is made by the publisher), but classic books which are out of copyright all seem to have this feature enabled.

So, is the Kindle the best electronic book for people with low vision? I would still say the iPad is better for people with reduced contrast sensitivity or severely reduced visual acuity, but this Kindle is certainly better than its predecessor. Many people will prefer the reduced screen reflection and lower glare of the Kindle’s electronic ink display, and the fact that it is so much lighter than the iPad will be helpful for people that use close working distances to read. Perhaps most significantly, it’s only a quarter of the cost!

Ideally people with low vision considering electronic books should try and borrow each of these devices and should read, at home, for an extended period of time with each one. I imagine both the Kindle and the iPad will be useful to many people with visual impairment.

The movie “going blind” has been attracting considerable attention in the low vision research community. I finally got to see this at the Envision meeting in September, and I reviewed it for Optometry Today. My review is reprinted below:

When film director Joseph Lovett visited his ophthalmologist for a glaucoma review, the doctor told him not to think about what would happen if the disease made him go lose his sight. However, he did think about it. The result is “Going blind”, a fascinating 80-minute documentary feature film about visual impairment and blindness.

The film is set against the backdrop of Lovett’s own glaucoma getting worse. In fact he had several surgical procedures including a failed trabeculectomy during the course of making the movie. In the documentary Lovett meets several people with visual impairment and asks them how they cope with their vision loss. These include Jessica Jones, a young artist and photographer who lost sight through retinal detachments. She now teaches art accompanied by her guide dog, Chef. Emmet Tyran features too. He is a child with albinism whose parents encourage him to perform stand-up comedy to as a way of dealing with children who make fun of him in class for having to get so close to the board to see.

However, Pat Williams is the real stand-out character. She knew it was time to seek help from low vision services when her failing sight meant she accidentally added cinnamon rather than paprika to chicken when cooking at for a dinner party. The way in which she discusses the psychological issues surrounding her own vision loss is fascinating. In one amusing scene she is shopping for new shoes. After picking up a pair of some lurid purple boots she asks her brother: “Is this brown?”. When he corrects her she says: “But it will look brown”. He tells her they will always look purple. Her response? “Ooh, nice”.

The film also shows the director attending glaucoma and low vision appointments in Manhattan. Some of the communication skills shown by his ophthalmologist are quite shocking. Even with the presence of a camera crew he seems unwilling to discuss the possible progression of Lovett’s glaucoma, and seems to be far more interested in IOP control than in Lovett’s well being. Speaking as a low vision optometrist myself, I’m pleased to report that the optometrist and low vision specialists who the director visits come across as more caring. Indeed, the film could usefully be shown to people who are sceptical of low vision services to show the benefits low vision rehabilitation can have.

The film is not without faults. With the possible exception of Steve Baskis, an Iraq war veteran blinded in both eyes, most of the characters are extremely upbeat throughout the film. I can see why the director wanted to create an optimistic, ‘feel-good’ movie, but I think it would have been informative to demonstrate that it is normal to be frustrated or angry with vision loss at times. Also, although I saw the film on a big screen at a preview, I think the tone of the film makes it appear more like a (well-made) television documentary than a gripping documentary film such as “Food, Inc” or Michael Moore’s “Sicko”.

Going Blind is an interesting, informative and entertaining movie. Anyone working with visual impairment can learn from watching it, and it would take a heart of stone not to find some elements of the film inspiring.

I particularly enjoyed the contribution from Jan Lovie-Kitchin from Australia, who presented very interesting work on mobility in visual field loss. She is trying to determine the point at which people with visual field loss should be referred for mobility training (I had always assumed people need referral when they report mobility difficulties: of course the best situation would be people get assessed BEFORE they have mobility difficulties). Other highlights for me were some of the research presentations, and the keynote talks by Aries Arditi and Bob Massof.

I was a bit disappointed by the large proportion of speakers who were from the USA and particularly the implication by one speaker that “the USA is the best for low vision care and maybe one day Europe will catch up”. Low vision care in much of Europe, particularly in Holland and Sweden, is (in my opinion) superior to that offered in much of the USA. Whats more, low vision devices are state funded in much of Europe…

It was a shame that the research sessions did not have translation and weren’t stratified by language, so many sessions had a couple of Spanish presentations then a couple of English presentations. For those of us with no Spanish this made the conference a bit difficult to navigate. Further, the programme did not include the speaker’s name in the research sessions which was frustrating.

Apart from these minor gripes, the conference was enjoyable and informative. I hope there are many more European meetings which follow this model.

Of course, the big new gadget for electronic books is the Apple iPad. I still haven’t bought one (I can’t really imagine what I’d use it for) but several patients I have seen recently really like it as a low vision reading device. I finally had chance to measure some screen parameters on a friend’s iPad yesterday.

The good news is that, unlike the electronic paper based devices, the screen is very high contrast: its maximum luminance is approximately 270 candelas per metre squared, and its minimum is around 0.5 cd/m sq. This means that the maximum Michelson contrast which can be displayed is very nearly 100%: making this a far better option for reading with reduced contrast sensitivity than a newspaper (Michelson contrast around 70%), a paperback book (about 75%) or a electronic paper device such as the Kindle (60%).

Whereas the iBooks application does not support reversed contrast, many third party readers (such as Stanza) will allow contrast to be reversed, so that text can be displayed as white on a black background. This text format is often preferred by people with media opacities, such as those who have cataract or corneal dystrophies, and those who suffer from increased glare (such as people with retinitis pigmentosa). These readers also allow increased text size (the maximum x-height on iBooks is 3.5mm, equivalent to about 2.4M (about two and a half times newsprint).

I have also been surprised by who has used an iPad: even some of those who refuse to use a computer have mastered downloading and reading books on an iPad: and it’s also useful for viewing photographs and web pages with the ‘pinch to enlarge’ touch gesture.

For visually impaired users, I think the iPad certainly beats the competition for now. However, as someone with good contrast sensitivity and visual acuity who likes physical books and newspapers I’m not sure I’ll be buying one yet.